Emer Currie (Fine Gael)
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Gabhaim buíochas leis an gCathaoirleach Gníomhach. I am very grateful to the Minister of State for attending today.

To put this very simply, we need more psychologists in Ireland. Why, if we are in chronic need of more psychologists, do we put so many barriers in the way of getting them? It is not because we do not have the talent, commitment and ambition. I am aware the Minister of State is familiar with and cares about this information. Just to recap, staff in the child and adolescent mental health services, CAMHS, are overwhelmed, and one told me that is the worst they have ever experienced. The delivering specialist mental health services 2019 report states that the percentage of new development posts being filled went from 69% in 2017 to 17% in 2018, and 32% in 2019. We know of the waiting lists across community mental health teams, early intervention and school-age teams. I understand that is being changed, and is progressing to disability teams at the moment.Despite these backlogs and the acute personal pain and social problems that persist, there are systemic barriers to getting qualified psychologists onto the front line to deal with them and to build what we require, which is a diverse workforce of psychologists. We are overseeing a deeply inequitable and unhealthy system in which only a very small number of psychologists eventually qualify, and many who do are in dire financial straits for pursuing their calling.

It is an incredibly competitive system and not many people make it onto the doctorates, and I say that as a female politician. Their commitment and resilience are something else. They undergo and pay for their undergraduate course, which is four years, and then a masters, which is two years, followed by work experience which could be another two years. They try to obtain an assistant psychologist post which, as we have seen recently, can be unfunded or voluntary. That work experience is required to secure a doctorate. Incidentally, assistant psychologists are not replacements for fully qualified psychologists. Then, if they are lucky, they might secure one of the coveted places on the island for their doctorate, where they could pay €15,000 per year to do it over three years and during which they work a minimum of 300 hours, and it could be 450 hours, unpaid throughout the duration of their studies. That is 11 years, mainly self-funded, even though the health service is in critical need of their care, commitment and expertise. However, if one gets a place on a clinical trainee doctorate, one gets 60% of one's fees paid and receives a student salary starting at €33,000 for one's work experience. However, if one takes the route of counselling in education one gets nothing when doing the doctorate, even though all three strands - clinical, counselling and educational - are eligible for the same posts when people are qualified.

I believe in equality of opportunity, as does the Minister of State. We need a fully functional health service that places the citizen at the centre of care. Where we see solutions before us in terms of educational and professional attainment, addressing our mental health crisis and helping people who need it most, we have an obligation to execute those solutions. A very small step that would cost the Exchequer only €1.5 million per year is to make access to funding for doctorates equitable. That is what I hope the Minister for State will commit to today. There are other things we can do to break down the barriers, but this is one small step. To break the backlogs we must break down the barriers.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Currie for giving me the opportunity to update the House on behalf of the Minister of State, Deputy Butler, on this important matter and to acknowledge the enormous contribution made by psychologists in Irish hospitals, especially in these challenging times in the context of the Covid-19 pandemic. The Department engages on an ongoing basis with the HSE with regard to improving the position of all healthcare workers and trainees, but it must be noted that it is the Psychological Society of Ireland, not the Department of Health, which currently sets the academic and professional requirements to attain the status of professionally qualified psychologist in clinical, counselling and educational psychology.

In February 2019, HSE community operations convened a project team, chaired by Dr. Cathal Morgan, to consider the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The project team was tasked with, inter alia, considering the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The work of the project team has been informed by a thorough stakeholder consultation process but, unfortunately, due to the recent public health emergency the work of the project team was paused in March 2020 and reconvened in early August 2020. It is expected that the report of the project team will be finalised in the coming weeks for presentation to HSE community operations for consideration.The HSE has indicated that the report will set out the significance of establishing governance and oversight structures; developing a formal and robust system to manage and co-ordinate placements for staff that wish to complete additional placements, either as part of professional development and-or to meet the identified eligibility criteria for employment in the HSE; building communications and engagement processes with cross-sectoral stakeholders; and a review of the current funding model to ensure the appropriate supply of the future psychologist workforce. The Senator will be happy to note that a review of the current funding model to ensure the appropriate supply of the future psychologist workforce is envisaged by the project team.

Underlining the Government's commitment to mental health, budget 2021 saw an increase of €50 million, bringing the total budget to over €1.1 billion, of which €23 million is for implementation of many of the short-term recommendations of Sharing the Vision. This will fund 153 new staff in community mental health services, including 29 posts for child and adolescent mental health services, CAMHS, and telehealth hubs, bereavement counselling, employment supports, crisis resolution teams and development of the national clinical programmes. Some €15 million in once-off funding will address the additional challenges posed by Covid-19.

In 2018, 114 new assistant psychologists and 20 psychologists were recruited to HSE primary care and this has helped relieve pressures and inappropriate referrals to the specialist CAMHS service. There is currently significant health workforce recruitment under way in the HSE. At the end of March 2021, health service employment levels stood at 128,283 whole-time equivalents.

While it is a matter for the HSE at operational level to determine the level of recruitment required across staff categories, given the level of workforce expansion required it is likely there will be additional posts available for professionally trained psychologists.

Emer Currie (Fine Gael)
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I thank the Minister for that response. He correctly mentioned the Psychological Society of Ireland, a fantastic organisation in setting out good standards and best practice. I have worked with it regarding a charity called Social Anxiety Ireland. If it is setting out the academic and professional requirements, it will be done with best practice and standards at its core. I am glad to hear that the project team has been reconvened and that a review of the current funding model to ensure the appropriate supply of future psychologist workforce is envisaged by the project team. I emphasise that this is a small measure that will go a long way.

In the North, they have increased the number of places in training and we need to look to that. Overall, we have to ensure there is a pipeline of qualified, trained, exceptional psychologists, which I know we have, making it through to the front line to help us.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for the information, especially relating to the North. It is an interesting recommendation. Significant health workforce recruitment is under way in the HSE and more is planned. This is a challenging time for the health sector but there are opportunities for reform and new ways of working. The Minister of State, Deputy Butler, is looking forward to receiving the report of the project team convened to consider preparation of a workforce plan for psychological services in the HSE. The Minister of State and I consider this an encouraging development in healthcare.

Our Department is committed to supporting all healthcare workers having training opportunities and appropriate supervision while training. A lot is happening and I hope we will be in a better space in a few weeks or months time.